Provider Demographics
NPI:1306844121
Name:PERRY, DOUGLAS ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ADAM
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:89 INTERCHANGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7661
Mailing Address - Country:US
Mailing Address - Phone:912-527-5301
Mailing Address - Fax:912-756-4740
Practice Address - Street 1:89 INTERCHANGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7661
Practice Address - Country:US
Practice Address - Phone:912-527-5301
Practice Address - Fax:912-756-4740
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG40753Medicaid
GA000742783AMedicaid
GA650896OtherBCBS
SCG40753Medicaid
GA11DBMBWMedicare PIN